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What Is A Complex Migraine

If You’ve Been Diagnosed With Complex Migraine You Could Be Given The Wrong Medication

Ask the Expert: Complex Migraines Explained

Many of the symptoms you describe could be consistent with Migraine with Aura and Migraine Complications. Symptoms can include weakness, loss of vision, or difficulty speaking in addition to a headache often mimicking a stroke. Check your symptoms here, and discuss these with your doctor. If your doctor isn’t up to date, you’ll want to talk to a board-certified headache specialist to be sure.

In the 2011 video below, David Dodick, M.D., neurologist, Mayo Clinic in Arizona, explains the symptoms, triggers and treatment for complex migraines – or the official term, Migraine with Aura. A nationally recognized expert on headaches, Dr. Dodick is the president of the American Headache Society, Editor-in-Chief of Cephalalgia, Director and Founder of the Headache Program and Headache Fellowship Program at Mayo Clinic in Arizona.

When To Get Medical Advice

You should see a GP if you have frequent or severe migraine symptoms.

Simple painkillers, such as paracetamol or ibuprofen, can be effective for migraine.

Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.

You should also make an appointment to see a GP if you have frequent migraines , even if they can be controlled with medicines, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you’re with experiences:

  • paralysis or weakness in 1 or both arms or 1 side of the face
  • slurred or garbled speech
  • a sudden agonising headache resulting in a severe pain unlike anything experienced before
  • headache along with a high temperature , stiff neck, mental confusion, seizures, double vision and a rash

These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.

What Are The Symptoms Of Migraines

The primary symptom of migraine is a headache. Pain is sometimes described as pounding or throbbing. It can begin as a dull ache that develops into pulsing pain that is mild, moderate or severe. If left untreated, your headache pain will become moderate to severe. Pain can shift from one side of your head to the other, or it can affect the front of your head, the back of your head or feel like its affecting your whole head. Some people feel pain around their eye or temple, and sometimes in their face, sinuses, jaw or neck.

Other symptoms of migraine headaches include:

  • Sensitivity to light, noise and odors.
  • Nausea and vomiting, upset stomach and abdominal pain.
  • Loss of appetite.
  • Feeling very warm or cold .
  • Pale skin color .
  • Euphoric mood.

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A Better Way Forward For Migraine Patients

An accurate diagnosis is absolutely necessary. It sets the foundation for treatment. Without the right diagnosis, how can you possibly expect to get the right treatment? Hemiplegic migraine is treated differently than migraine with aura or migraine with brainstem aura. Any one of those migraine diagnoses can be labeled complex or complicated by healthcare professionals who are not truly qualified to treat headache disorders.

Important Clinical Features And Considerations

The different Types of Migraines

Migraine is a condition that warrants specific consideration. Complicated migraines in which the patient presents with focal neurologic abnormalities may initially be diagnosed as stroke. A classic history with aura or other migraine-associated symptoms is frequently absent in children with migrane headaches.29 The neurologic deficit may last from hours to days and can vary from subtle abnormalities to dense hemiplegia. In cases in which this is suspected, early neuroimaging is still required to exclude a central nervous system vascular event or other intracranial pathology before expectant management may be safely pursued. Further complicating this entity is the possibility of migraine actually causing an ischemic stroke. While accepted in the adult population,30,31 the development of cerebral infarction as a consequence of migraine in childhood has not been definitively described. Several small studies, however, support the concept.29,32

K. Sivakumar, … M.C. Leary, in, 2017

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When Should I Seek Immediate Help Or Contact My Healthcare Provider

  • You are experiencing the worst headache of my life.
  • You are having neurologic symptoms that youve never had before, including speaking difficulty, balance problems, vision problems, mental confusion, seizures or numbing/tingling sensations.
  • Your headache comes on suddenly.
  • You have a headache after experiencing a head injury.

Schedule a visit with your healthcare provider if:

  • The number or severity of your headaches increase or your headache pattern changes.
  • Your medications no longer seem to be working or youre experiencing new or different side effects.

What Are The Symptoms Of A Migraine

Individual migraines are moderate to severe in intensity, often characterized by a throbbing or pounding feeling. Although they are frequently one-sided, they may occur anywhere on the head, neck and face or all over. At their worst, they are typically associated with sensitivity to light, noise and/or smells. Nausea is one of the most common symptoms and it worsens with activity, which often results in patient disability. In many respects, migraines are much like alcohol-related hangovers.

Migraine pain can be felt in the face, where it may be mistaken for sinus headache or in the neck, where it may be mistaken for arthritis or muscle spasm. Complicating the diagnosis of migraine is that the headaches may be accompanied by other “sinus like” symptoms, including watering eyes, nasal congestion and a sense of facial pressure. Most patients who think they have sinus headache in fact have migraines.

In up to 25 percent of patients, the migraine headache pain may be preceded by an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins. While the most common type of migraine aura involves visual disturbances , many people experience numbness, confusion, trouble speaking, vertigo and other strokelike neurological symptoms. Some patients may experience auras without headaches.

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Summary Of Hemiplegic Migraines

Because symptoms of hemiplegic migraine are also symptoms of other conditions such as stroke and epilepsya hemiplegic migraine attack can be quite frightening, both to the migraineur and to those witnessing the attacks. Proper diagnosis and treatment are especially essential with this form of migraine. Imaging studies and other testing should be performed to rule out other causes of the symptoms. It is important that people with hemiplegic migraine understand their migraines as well as possible. With continuing research, especially genetic research, more is being learned about hemiplegic migraine. As this research continues, living with hemiplegic migraine will become easier.

What Is A Complex Migraine

Migraine Headaches : Symptoms of Complex Migraines

This is a severe type of headache that millions of people suffer from. It can be an inherited condition that overall affects around three times more women than men. 30% of people who suffer from traditional migraines also suffer from complex migraines, also known as a migraine with aura.

This head pain can last for as long as a couple of hours to several days and can be extremely disabling. For this type of migraine, other symptoms of sensory disturbance are also present and can seriously affect functioning. The accompanying aura itself can last for up to an hour.

An aura is defined as a sensation that occurs before the onset of a full-blown migraine attack. It is the bodys way of alerting you to the fact that the condition is about to set in. At this point, you will experience a sensory disturbance consisting of the sensation of seeing flashing lights before ones eyes, blurred or double vision, or difficulty speaking. You may feel symptoms which include weakness and dizziness as well.

In some cases, this ailment can even resemble a stroke, so it is incredibly important to be aware if you or someone you know has a predisposition to this complex migraine condition. Weakness of one side of the body and difficulty speaking are two of the symptoms that result in this condition being misunderstood as a stroke. Recognizing warning signs and triggers are key to formulating an understanding of what this form of migraine is this will be touched on later in this article.

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What Medications Are Used To Relieve Migraine Pain

Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain relieving medications are ibuprofen, aspirin, acetaminophen, naproxen and caffeine.

Three over-the-counter products approved by the Food and Drug Administration for migraine headaches are:

  • Excedrin® Migraine.
  • Advil® Migraine.
  • Motrin® Migraine Pain.

Be cautious when taking over-the-counter pain relieving medications. Sometimes overusing them can cause analgesic-rebound headaches or a dependency problem. If you’re taking any over-the-counter pain medications more than two to three times a week, report that to your healthcare provider. They may suggest prescription medications that may be more effective.

Prescription drugs for migraine headaches include:

Triptan class of drugs :

  • Sumatriptan.
  • Butterbur.
  • Co-enzyme Q10.

Drugs to relieve migraine pain come in a variety of formulations including pills, tablets, injections, suppositories and nasal sprays. You and your healthcare provider will discuss the specific medication, combination of medications and formulations to best meet your unique headache pain.

Drugs to relieve nausea are also prescribed, if needed.

All medications should be used under the direction of a headache specialist or healthcare provider familiar with migraine therapy. As with any medication, it’s important to carefully follow the label instructions and your healthcare providers advice.

Structural And Functional Brain Alterations

Brain alterations can be categorized into the following two processes: alteration in brain function and alterations in brain structure . Functionally, a variety of imaging techniques used to measure relative activation in different brain areas in migraineurs revealed enhanced activation in the periaqueductal gray ; red nucleus and substantia nigra ; hypothalamus ; posterior thalamus ; cerebellum, insula, cingulate and prefrontal cortices, anterior temporal pole, and the hippocampus ; and decreased activation in the somatosensory cortex , nucleus cuneiformis , caudate, putamen, and pallidum . All of these activity changes occurred in response to nonrepetitive stimuli, and in the cingulate and prefrontal cortex they occurred in response to repetitive stimuli . Collectively, these studies support the concept that the migraine brain lacks the ability to habituate itself and consequently becomes hyperexcitable . It is a matter of debate, however, if such changes are unique to migraine headache. Evidence for nearly identical activation patterns in other pain conditions, such as low back pain, neuropathic pain, fibromyalgia, irritable bowel syndrome, and cardiac pain , raises the possibility that differences between somatic pain and migraine pain are not due to differences in central pain processing.

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    What Is Migraine With Aura

    A migraine aura describes neurological symptoms that occur prior to a migraine attack. Symptoms of a migraine aura can include problems with:

    • Vision
    • Sensations
    • Speech
    • Motor functions

    Migraine aura symptoms last just a few minutes and should not leave any lasting effects. It is common for aura symptoms to occur only on one side of the body or one side of the visual field. After migraine aura symptoms resolve, usually a migraine attack or headache will occur.

    Migraine aura symptoms and signs are very similar to stroke or transient ischemic attack . If you think you or someone you know is having a stroke, remember FAST.

    Pathophysiologically Based Clinical Differentiation Of Migraine And Seizure

    tia or complex migraine tia or complex migraine ...

    Migraine and epilepsy share a common pathophysiologic mechanism. Thus, it is not a surprise that both are quite similar in almost all aspects of their clinical manifestations and treatment strategies. Both events are triggered by an altered neocortical excitability. In migraine it is secondary to cortical spreading depression. The cortical spreading depression is a self-propagating wave of neuronal and glial depolarization that spreads across the cerebral cortex. The neocortical spreading provokes the expression of c-fos protein-like immunoreactivity within trigeminal nucleus caudalis via trigeminovascular mechanisms. In contrast, the seizure is secondary to hypersynchronous neuronal activity. This neurophysiologic difference, their relative speed of spread, are the basis for a clinical differentiation between migraine and seizure. Migraine evolves slowly and seizure onset is sudden and fast. Most ictal periods in seizure last less than 3 min while migraine episode evolves over and beyond 10 min.

    It should be noted that clinical manifestations, sensory, psychosomatic, autonomic, and motor dysfunctions, are the same in both migraine and seizure. But sensory symptoms predominate in migraine while seizure is characterized by motor activity.

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    Enhancing Healthcare Team Outcomes

    A hemiplegic migraine is a very;rare migraine headache accompanied by unilateral weakness. It can be very upsetting to the patient and their family. Typically an interprofessional approach involving a nurse experienced;in headache education working with a clinical headache specialist to educate the patient and family will result in the best outcome.

    Can Migraines Cause A Stroke

    Migraine and stroke may occur at the same time, but a causal link has not been established. When an ischemic stroke occurs during a migraine attack, it is called a migrainous infarction.

    Migraine and stroke risk factors

    In a very small population of patients with specific symptoms, migraines may be related to a higher risk of stroke. Migraines may be a risk factor for stroke, in that strokes occur more frequently in people who have had migraines, but the strokes do not necessarily occur during migraine attacks. The specific type of migraine associated with an increased risk of ischemic stroke is migraine with aura, a type of migraine that affects about one-quarter of all migraine patients. Moreover, women who have migraine with aura are at a greater risk for stroke than women without migraine, or even men who experience migraine with aura.

    People with migraines at highest risk for stroke are those who also have traditional risk factors for stroke such as high blood pressure, diabetes, high cholesterol, smoking, and obesity.

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    What Symptoms Must You Have To Be Diagnosed With A Migraine

    Migraine with aura . This is a headache, plus:

    • Visual symptoms or vision loss.
    • Sensory symptoms .

    Migraine without aura . A common migraine is a headache and:

    • The attacks included pain on one side of your head.
    • Youve had at least five attacks, each lasting between four and 72 hours.

    Plus, youve experienced at least one of the following:

    • Nausea and/or vomiting.
    • Lights bother you and/or you avoid light.
    • Sounds bother you and/or you avoid sounds.

    What Is The Prognosis For People With Migraines

    Complex Migraine – Mayo Clinic

    Migraines are unique to each individual. Likewise, how migraines are managed is also unique. The best outcomes are usually achieved by learning and avoiding personal migraine triggers, managing symptoms, practicing preventive methods, following the advice of your healthcare provider and reporting any significant changes as soon as they occur.

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    What Are The Treatments For Migraines And Strokes

    Migraine treatment

    There is no cure for migraine, but the headaches can be managed with:

    Stroke treatment

    Stroke is a medical emergency. If you have stroke symptoms, call 9-1-1 and get medical attention immediately.

    It is important to CT scan the patients brain to diagnose an ischemic stroke from a hemorrhagic stroke because the emergent treatments are very different.

    Blood thinners are the most common treatment for acute ischemic stroke. The clot buster drug used in emergency settings is called alteplase , also referred to as tPA and it must be administered within 3-4.5 hours of the onset of stroke symptoms for the best chance of recovery. Patients who cannot receive tPA may receive blood thinners such as aspirin and clopidogrel. Some stroke patients also may need, or benefit from, intra-arterial blood thinners or clot retrieval devices.

    Patients with carotid artery disease may get a carotid endarterectomy or carotid artery angioplasty to open blocked carotid arteries.

    Who Gets Migraines What Are The Risk Factors

    Its difficult to predict who may get a migraine and who may not, but there are risk factors that may make you more vulnerable. These risk factors include:

    • Genetics: Up to 80% of people who get migraine headaches have a first-degree relative with the disease.
    • Gender. Migraine headaches happen to women more than men, especially women between the ages of 15 and 55. Its likely more common in women because of the influence of hormones.
    • Stress level. You may get migraines more often if youre high-stress. Stress can trigger a migraine.
    • Smoking.

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    What Is An Aura

    An aura is a group of sensory, motor and speech symptoms that usually act like warning signals that a migraine headache is about to begin. Commonly misinterpreted as a seizure or stroke, it typically happens before the headache pain, but can sometimes appear during or even after. An aura can last from 10 to 60 minutes. About 15% to 20% of people who experience migraines have auras.

    Aura symptoms are reversible, meaning that they can be stopped/healed. An aura produces symptoms that may include:

    • Seeing bright flashing dots, sparkles, or lights.
    • Blind spots in your vision.
    • Numb or tingling skin.

    What Questions Should I Ask My Healthcare Provider

    Hemiplegic migraine. It
    • Will my child grow out of their migraines?
    • What medications do you recommend for me?
    • What should I change about my lifestyle to prevent my migraine headaches?
    • Should I get tested?
    • What type of migraine do I have?
    • What can my friends and family do to help?
    • Are my migraines considered chronic?

    A note from Cleveland Clinic

    Migraine headaches can be devastating and make it impossible to go to work, school or experience other daily activities. Fortunately, there are some ways to possibly prevent a migraine and other ways to help you manage and endure the symptoms. Work with your healthcare provider to keep migraines from ruling your life.

    Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.

    References

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